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Anal Papillitis

Anal papillitis

  • What are Anal Papillae?

    • Inside your rectum, there are tiny folds called anal papillae. These are usually small and don’t cause any problems.
    • They can have different shapes, like a wide base or a narrow stalk.

  • When do they become a problem?

    • Anal papillae can become inflamed (papillitis) if they get irritated or infected.
    • This can happen if they are:
      • Too large
      • Injured by hard stools or other irritants
      • Infected by bacteria from nearby inflamed areas

  • What are the symptoms?

    • When inflamed, the papillae can become swollen, red, and sore.
    • You might experience:
      • Discomfort or pain, especially during bowel movements
      • Itching or burning around the anus
      • Feeling like you need to have a bowel movement even when you don’t

  • Diagnosis:

    • Your doctor can usually diagnose inflamed anal papillae during a physical examination.

Reasons Papillitis

Papillitis is the term used to describe inflammation of the anal papillae. This condition typically occurs when the papillae become enlarged and may protrude from the anus. In some instances, these prolapsed papillae can reach a significant size, up to 3-4 centimeters in diameter.

Several factors can contribute to the enlargement of anal papillae (hypertrophy):

  1. Mechanical injury and irritation: This can occur due to the passage of hard or excessively loose stools.
  2. Poor blood circulation: Conditions like hemorrhoids, which affect blood flow in the pelvic region, can contribute to papillae enlargement.
  3. Inflammation: Inflammatory conditions within the anal canal, particularly cryptitis (inflammation of the anal glands), can play a significant role in the development of enlarged papillae. The presence of hypertrophied papillae often indicates the presence of underlying inflammation in the anal canal.

Diagnosis Papillitis

The first step in diagnosing papillitis is for your doctor to gather information about your symptoms and medical history.

A physical examination will be performed, including a visual inspection of your anal area both at rest and during straining.

Your doctor may also use other diagnostic tools, such as:

  • Digital rectal examination: A manual examination of your rectum.
  • Anoscopy: A procedure that uses a short, rigid scope to examine the anal canal.
  • Sigmoidoscopy: A procedure that uses a flexible scope to examine the lower part of your colon.

These examinations help your doctor assess the condition of your anal canal, identify enlarged papillae, and rule out any other underlying conditions.

Differential Diagnosis Papillitis

While hypertrophied anal papillae can cause noticeable symptoms, these symptoms aren’t unique to this condition. They can also occur in other rectal diseases. Therefore, it’s essential to differentiate enlarged papillae from other conditions, most notably colon polyps, through careful examination and diagnosis.

The differential diagnosis of rectal lesions necessitates distinguishing hypertrophied anal papillae from other entities, including polyps and “sentinel piles.” While hypertrophied papillae may exhibit a polypoid appearance, true polyps are characterized by their location superior to the anorectal line, adenomatous structure, and columnar epithelial lining. Anal papillae, conversely, are located at the anorectal line and are composed of collagen and adipose tissue, covered by stratified squamous epithelium. The presence of “sentinel piles” in the context of anal fissures or hemorrhoids should also be considered.

Internal hemorrhoids differ from hypertrophied anal papillae in location (above the anorectal line), color (dark red), and consistency (soft). Treatment for anal papillae focuses on symptom management. If no symptoms are present, no treatment is needed. If symptoms like prolapse or pain occur, excision is the typical approach, often including the crypt and semilunar valve, and is usually done under local anesthesia. Papillitis is managed conservatively, and papilla removal is considered only after inflammation resolves. It’s crucial to remember that anal papilla inflammation is rarely isolated and warrants investigation for underlying causes.